Quality of care in Hunan Province nursing homes: relationship to staffing and organizational climate

Background: Confounding factors, such as staff characteristics and organizational features, are neglected in most studies when assessing the relationship between staffing levels and quality of care,and previous research provides inconsistent conclusions.The aim of this study wasto examine the quality of care perceived by nursing staff and its relationship with the staffing and organizational climate in nursing homes. Methods: A cross-sectional study was conducted. This study included 358 nursing staff from 52 units in 26 nursing homesin Hunan Province, China. Organizational climate was assessed with the Nursing Home adaptation Shortell scale and work stress scale. Staffing levels were studied by interviewing unit managers. Self-reported quality of care was measured with a single item. Results: The interaction effect between nursing staff to resident ratio and physician to resident ratio was significant on quality of care (p<0.05). Higher score on the relationships and communication scale (OR=4.771, p=0.002) and lower score on the work stress scale (OR=0.980, p=0.050) were also associated with better quality of care. More work experience was related to lower quality of care (OR=0.942, p=0.044), and work experience was associated with relationships and communication (Beta=0.115, p= 0.037) and work stress (Beta=0.234, p=0.000). Conclusions: Staffing level, work experience, work stress, relationships and communication are key factors to consider when the objective is to provide higher quality of care in nursing homes.